1. Opinion

Trump found a way to simultaneously sabotage our health care and immigration systems

This administration is consistent only in its desire to destroy as many institutions as possible. | Catherine Rampell
Catherine Rampell
Published Oct. 8

President Donald Trump sabotaged the health care system. Separately, he’s sabotaged the immigration system.

And now, in a presidential twofer, on Friday night the administration found a way to sabotage both simultaneously.

Unable to repeal Obamacare, the Trump administration has worked to make it less functional and more expensive. It has done this by zeroing out the individual mandate, expanding the availability of cheap but worthless junk insurance and curtailing the annual open-enrollment period, among other actions.

The cumulative effect of these policies has been to reduce the share of people who have (real, non-junk) insurance; those still motivated to seek comprehensive insurance tend to be sicker and more expensive to cover. The predictable result? Premiums hundreds of dollars higher than they would otherwise be, according to estimates from health care analyst Charles Gaba.

And, unsurprisingly, those who don't qualify for the subsidies that shield enrollees from these price hikes are dropping out of the individual market altogether because they can't afford the insurance.

But no worries. For years, administration officials and fellow Republican lawmakers have argued this is merely an expansion of a fundamental American freedom -- the freedom to go uninsured.

Simultaneously, of course, the administration has also been undermining our legal immigration system. Emphasis on "legal" here: For all of Trump's vitriol for undocumented immigrants, he's also been targeting people who are trying to come to this country lawfully.

Among the creative, non-legislative ways the administration has sabotaged the legal immigration system: huge and arbitrary delays in visa and citizenship application processing; cruel and inhumane treatment of families seeking asylum; reductions in the refugee admissions cap to its lowest level on record; and, of course, the travel ban placed on several majority-Muslim countries.

And then there are all of the policies intended to penalize legal immigrants whom the Trump administration claims are a financial burden.

To be clear: Immigrants are in fact a net fiscal boon to the United States, according to a report from the National Academies of Sciences, Engineering and Medicine, and their children are “among the strongest economic and fiscal contributors in the U.S. population.” But Trump and his aides are convinced that immigrants are, and will forever be, a drain on society.

Or, as Trump's acting U.S. Citizenship and Immigration Services director Ken Cuccinelli put it: "Give me your tired and your poor who can stand on their own two feet."

Cuccinelli was talking about a new administration rule -- currently being challenged in eight lawsuits -- that makes it harder for immigrants to receive green cards if they have ever used or might someday need safety-net benefits such as food stamps or Medicaid. But it's actually one of several policies the administration has devised to drive down immigration numbers under the guise of fiscal prudence.

The latest such development was rolled out Friday night. This new policy, issued via presidential proclamation, bars issuance of visas to immigrants unless they can prove they will obtain health insurance within 30 days of their arrival in the United States, or otherwise demonstrate that they can pay medical expenses out of pocket.

That's right, the Trump administration has brought back the individual mandate, but for immigrants only -- the GOP's supposed commitment to "freedom" notwithstanding. The Migration Policy Institute estimates the change could end up excluding about two-thirds of future immigrants.

The new policy is vague about how would-be immigrants would even be able to prove they meet the new requirement. Maybe they'd need to somehow buy insurance before they leave their home countries, while still waiting in that interminable visa queue; maybe not.

What's more, if they get subsidized insurance through the individual exchanges, Trump's proclamation says it won't count. This is yet another way the administration is sabotaging Obamacare, which explicitly allows immigrants to purchase subsidized exchange insurance. It also places low- and moderate-income immigrants in an impossible position, since they're now stuck buying insurance at the sticker prices that the Trump administration has helped jack up through its earlier rounds of Obamacare sabotage.

Under the proclamation, immigrants could instead buy junk insurance. But, as the administration also surely knows, these Trumpcare plans cover almost nothing. So forcing immigrants to buy such policies seems unlikely to shield taxpayers (or hospitals) from immigrants’ emergency medical costs -- which is allegedly the goal here.

Of course there is also a fundamental tension between arguing that uninsured immigrants impose huge costs on the country but uninsured native-born Americans don't cost anyone anything. But no one said consistency was this administration's strong suit -- aside from its consistent desire to find new ways to destroy as many institutions as possible.

Catherine Rampell’s email address is Follow her on Twitter, @crampell.

© 2019 Washington Post Writers Group


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